Popular Resistance to Cost-Effectiveness Research: Two Stories and a Challenge

Measuring the cost-effectiveness of medical treatment seems unpopular - especially among conservatives. Why would this be? I have two stories - one fairly charitable, the other not so charitable.

The charitable story. Many people - even people who strongly favor heavy government subsidies for medicine - deeply distrust policy wonks. They fear that these wonks will use cost-effectiveness research to trump the medical decisions they'd like to make in consultation with their doctors (who they do trust). The simplest way to prevent the wonks from usurping patients' sovereignty is to prevent cost-effectiveness research from happening in the first place.

The not-so-charitable story. Resistance to cost-effectiveness research is yet another expression of the "get your government hands off my Medicare" mentality. Many conservatives (and even some libertarians) have come to equate limitations on Medicare reimbursements with "price controls" and limitations on Medicare covered treatments with "rationing." Given this perspective, cost-effectiveness research is merely an elitist rationalization for rationing. The simplest way to prevent this rationing is to prevent the rationalization from getting off the ground.

Intelligent liberals rightly see conservatives' resistance to cost-effectiveness research as ridiculous. Combining government financing with unlimited consumer choice is a prescription for fiscal disaster. Yet I challenge liberals to consider an unwelcome implication: In the United States, government-funded health care tends to be unusually expensive and unusually ineffective. Americans can learn to love government financing of medical care. They've been doing it for decades. But Americans won't stand for government financing with strings attached. No matter who pays the piper, Americans want patients to call the tune.

How about a simpler explanation. The public does not believe that Cost-effective research is real. Also, most non-wonks get that the research never applies to the wonks, politicians, bureaucrats, and their families. Cost-effective research is just another name for rationing other peoples goods.

Medical cost effectiveness research has a history of bias and misinterpretation. That's why many physicians distrust such research. I'll give a well-known example: post-hospital care of people who had myocardial infarctions. There were two patient groups: those cared for by cardiologists and those cared for by generalists (internal medicine physicians).

-- The death rates were the same for both patient groups.
-- The nonfatal reinfarction rates were the same for both groups.
-- The proportions of patients who returned to normal function were the same in both groups.
-- The costs of care were twice as high for the cardiologist group.

Health insurance companies used these results to "prove" that cardiologist care was wasteful.

Here are the findings the insurers downplayed:

-- The average recovery time (time until the patients could return to normal functioning) was four weeks in the cardiology group and nine weeks in the other group.

-- Patient satisfaction with care was much higher in the cardiology group.

Here is the finding the insurers completely ignored:

-- The shorter recovery time in the cardiologist group had great economic value to the patients, their families, and their employers. This economic value was more than twice the extra cost of cardiologist care vs. generalist care.

From every viewpoint except the insurers, cardiologist care was best. Substitute a government board in place of the insurers, and it's easy to understand the widespread unease with government-run medical cost effectiveness studies. Such unease is unrelated to political party affiliation.

Thank you Bryan! Our health care system is so expensive because everyone is required to pay, through premiums or taxes, for any treatment--regardless of cost or effectiveness--that a patient chooses with his or her physician. It's disgusting to see supposedly conservative publications like the WSJ arguing that every recipient of government-paid health care should have a right to demand any treatment without constraints. If people want to have health insurance that is a lot cheaper and more restrictive, like in Canada or the UK, they should be free to buy it in America. If we continue requiring that people pay for health care by buying buy unrestricted access to a health care "commons", we will surely go broke paying for it.

"Cost effectiveness research" resembles EPA research, which is to say, it produces political lies, authoritatively backed by "science" that no one is allowed to look at.

If one has a substantially socialist health care plan, and central planners operating it, then the central planners need cost effectiveness research to operate it, might well proceed to do so using business like methods, rather than pseudo scientific methods, in the unlikely event that the planners care whether the planned live or die.

However dressing up cost effectiveness research in robes of science is merely a strategy to dress decisions already made on political grounds in the august priestly robes of official science.

For cost effectiveness research to actually work, needs to be done by people who care about cost, which is to say a profit making business, and care about effectiveness, which is to say, benefit to customers.

Due to perverse incentives, governments seldom do genuine research, and never do genuine research on anything remotely political.

Doing real cost effectiveness research would be as smart a career move as measuring the IQ of blacks in high status careers.

Blogging software: Powered by Movable Type 4.2.1.
Pictures courtesy of the authors.
All opinions expressed on EconLog reflect those of the author or individual commenters, and do
not necessarily represent the views or positions of the Library of
Economics and Liberty (Econlib) website or its owner, Liberty Fund,
Inc.

The cuneiform inscription in the Liberty Fund logo is the
earliest-known written appearance of the word
"freedom" (amagi), or "liberty." It
is taken from a clay document written about 2300 B.C. in the Sumerian city-state of Lagash.